Computerized surveillance of adverse drug events in hospital patients.
Objective: To develop a new method to improve the detection and characterization of adverse drug events (ADEs) in hospital patients.Design: Prospective study of all patients admitted to our hospital over an 18-month period.Setting: LDS Hospital, Salt Lake City, Utah, a 520-bed tertiary care center a...
| Publicado en: | JAMA: Journal of the American Medical Association Vol. 266; no. 20; pp. 2847 - 2852 |
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| Autores principales: | , , , |
| Formato: | research Journal Article |
| Publicado: |
American Medical Association
11/27/91
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119391537&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 119391537 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00987484 AMA jtl: JAMA: Journal of the American Medical Association issn: 00987484 maglogo: N pubinfo: dt: 11/27/91 vid: 266 iid: 20 pid: 30 pub: American Medical Association place: Chicago, Illinois artinfo: ui: 119391537 119391537 NLM1942452 119391537 10.1001/jama.266.20.2847 NLM1942452 119391537 ppf: 2847 ppct: 5 formats: tig: atl: Computerized surveillance of adverse drug events in hospital patients. aug: au: Classen, D C Pestotnik, S L Evans, R S Burke, J P affil: Department of Clinical Epidemiology, LDS Hospital, Salt Lake City, UT 84143 sug: subj: Adverse Drug Event Drug Monitoring Hospital Information Systems Hospitalization Statistics and Numerical Data Hospitalization Economics Length of Stay Economics Adult Male Human Patient Record Systems Adolescence Bed Occupancy Length of Stay Statistics and Numerical Data Health Care Costs Causal Attribution Prospective Studies Utah Drug Therapy Economics Aged Child Female Middle Age Aged, 80 and Over Validation Studies Comparative Studies Evaluation Research Multicenter Studies Adult: 19-44 years Adolescent: 13-18 years Aged: 65+ years Child: 6-12 years Middle Aged: 45-64 years Aged, 80 & over Male Female ab: Objective: To develop a new method to improve the detection and characterization of adverse drug events (ADEs) in hospital patients.Design: Prospective study of all patients admitted to our hospital over an 18-month period.Setting: LDS Hospital, Salt Lake City, Utah, a 520-bed tertiary care center affiliated with the University of Utah School of Medicine, Salt Lake City.Patients: We developed a computerized ADE monitor, and computer programs were written using an integrated hospital information system to allow for multiple source detection of potential ADEs occurring in hospital patients. Signals of potential ADEs, both voluntary and automated, included sudden medication stop orders, antidote ordering, and certain abnormal laboratory values. Each day, a list of all potential ADEs from these sources was generated, and a pharmacist reviewed the medical records of all patients with possible ADEs for accuracy and causality. Verified ADEs were characterized as mild, moderate, or severe and as type A (dose-dependent or predictable) or type B (idiosyncratic or allergic) reactions, and causality was further measured using a standardized scoring method.Outcome Measure: The number and characterization of ADEs detected.Results: Over 18 months, we monitored 36,653 hospitalized patients. There were 731 verified ADEs identified in 648 patients, 701 ADEs were characterized as moderate or severe, and 664 were classified as type A reactions. During this same period, only nine ADEs were identified using traditional detection methods. Physicians, pharmacists, and nurses voluntarily reported 92 of the 731 ADEs detected using this automated system. The other 631 ADEs were detected from automated signals, the most common of which were diphenhydramine hydrochloride and naloxone hydrochloride use, high serum drug levels, leukopenia, and the use of phytonadione and antidiarrheals. The most common symptoms and signs were pruritus, nausea and/or vomiting, rash, and confusion-lethargy. The most common drug classes involved were analgesics, anti-infectives, and cardiovascular agents.Conclusion: We believe that screening for ADEs with a computerized hospital information system offers a potential method for improving the detection and characterization of these events in hospital patients. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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